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Introduction to the Couples Match

Couples Match University of Washington

University of Washington has a long history of success with the couples match. This means that our
institution is not only familiar with the stresses of couples matching, but is also able to anticipate potential
problems and avoid them. When applying to residencies, you must consider how well the different
programs communicate with each other. Communications between the Chairpersons, Residency Directors
and Chief Residents between the programs will only benefit the applicant. The communication at the
administration level is advantageous especially during the application process with scheduling interviews and
ranking.

What is the Couples Match?

The National Resident Matching Program (NRMP) allows any two people in the match to link their rank
list. You create your rank list together, and the system guarantees that you will be placed in a combination
that you have chosen. Both applicants will match at the highest rank combination in which both have been
accepted. In order to sign up for the Couples Match, you must designate it on your NRMP match list. You
do not have to decide to Couples Match until you submit your match list. The Electronic Residency
Application Service (ERAS) application does not require any information about Couples Matching.

Who can participate in a Couples Match?

Anyone two people can agree to Couples Match! Married couples, engaged couples, dating couples, best
friends or enemies. You can Couples Match with a person from another school, i.e., a Dartmouth-Brown
person. You do not need to be married or have any formal documentation of a relationship. In the case of
best friends or couples that want to be in the same program/area, you coordinate your match list so that you
can be near each other. As for enemies, they may chose to coordinate their lists so that, if one person is on
the east coast, the other person will be on the west coast to insure a good 3000 miles between the two. As a
couple, the NRMP will find your highest ranked choice combination that you both match.

When do we need to decide we are Couples matching?

You dont officially need to decide until you enter your Rank Order List (ROL) in mid-February. Its best,
however, to make the decision to Couples Match earlier rather than later. It is to your advantage most of
the time (see the Informing Programs of Couples match Status section below). Programs want to know
this information. It helps with setting up interview dates (see the Interviews section below).

What about matching with someone in the military?

This cannot be done through the couples match. The military has their own match system and the applicants
find out where they are going in December.

What about matching with someone who is applying in an early match specialty?

The early match specialties include Neurology, Neurosurgery, Ophthalmology, Otolaryngology, Plastic
Surgery and Urology. These applicants apply through SFMATCH (www.SFMATCH.org), except Urology,
which applies through AUANET (auanet.org/students/match). Most of these specialties find out where
they have matched in late January. Although it is not possible to Couples Match for the advanced specialty,
many of these early match specialties require a preliminary or transitional year, which CAN be linked
through the couples match (see What happens if we are applying for preliminary/transitional years and
advanced residencies? in the Making the Rank List section below).

-2TheApplicationProcess
When should we apply?

APPLY EARLY!!!! The ERAS application is available on the web starting in August/September. Try to get
your application certified in the first week or so that it is available. Applying early allows you the maximum
flexibility in scheduling interviews. Since you are Couples Matching, you will be applying to many
programs. The earlier you get interview invitations, the easier it is to coordinate your interview dates with
your partner. Most specialties send out invitations (usually via email) starting in late September/October
(they do not necessarily wait for the Deans Letter to invite you).

To how many programs should we apply?

Aim to rank at least 15 programs each. This means that you should apply to at least 25-30 each (the number
depends on how many programs actually exist in your specialty). It seems like a lot, but consider that, in
order to rank a place, both of you must get an interview at your respective programs and both must like the
programs and the city or area of the programs. Then in order to match at the programs, both of the
programs must like both of you. Cluster them in geographical areas as we discuss in the How do we choose
programs? section. You dont have to interview at all of them, but you do want to interview at as many as
you can tolerate so as to maximize possible combinations.

How do we choose programs?

1. Reputation
2. Geography
a. proximity to family
b. willingness to commute

If you plan to live together, try to aim for a maximum of 50 miles or so between programs. That way you
can live in between and each partner will have about a 25-mile commute. The Boston, Providence,
Worcester (U Mass) triangle is an example of this, and has been done by many couples. If Boston is
included, most couples live closer to Boston, because it takes longer to commute into Boston than into
Providence or Worcester. The Providence and Worcester combination is reputed to be easiest, because
there is not as much traffic. Be sure that there is a place to live that is half way between the two programs.
Consider Albuquerque and Santa Fe, between which there are very few towns, and those that exist are much
closer to Albuquerque. Also think of conditions that might lengthen the commuting time, i.e. weather
possibilities, traffic and quality of roads.
In addition, consider if you want to live near where you work. If it is important that your social life be
connected to your colleagues, you may not want to live 30 minutes from the hospital. It might mean having
to drive a distance if you want to meet a fellow resident for dinner or if you want to play in a resident soccer
game, for example. Also, if your partner is driving 30 minutes in the opposite direction, it might be hard to
meet each others fellow residents.
Consider, also, the benefit of working in the same hospital. It would be easier to meet for meals or to trade
car keys or whatever else you need to do as a couple. Also, it makes it easier to meet each others friends.
On the other hand, if you are applying in the same specialty, you may not want to be at the same hospital,
because that means the same program. You might need to make an effort to be scheduled for different
rotations, so you dont find yourself working together. You may prefer to work together, but it would
mean being on call on rotating nights, which would lead to less time together outside of the hospital.

-3Who decides how far apart a couple will be?

You do. Because you coordinate your match list, you set the limits of distance. You don't have to match at
the same hospital, same institution, the same city, or even the same side of the country. See Making the
Rank List section below.

Informing Programs of Couples match Status

Are we required to inform programs of our Couples match status?

No. You are not required to tell programs you are Couples Matching. The programs will not know you are
Couples Matching unless you inform them. You could actually wait until the Rank Order List is due in midFebruary to decide whether or not you are going to Couples Match, and still the programs will not know
unless you personally tell them. Only the NRMP will know.
You can find program-specific recommendations in FREIDA, a website with information about
residency programs (www.ama-assn.org/freida). For example, Beth Israel Deaconness Internal Medicine
program encourages applicants to indicate if they are Couples Matching by writing it at the bottom of the
personal statement.

Is there any benefit to informing a program that we are Couples Matching?

Yes, sometimes. It will make it easier to coordinate interview dates and obtain interviews at the same
institutions (see the Interviews section below). Programs deal with couples differently. For example,
many programs like couples, because they come together and are usually happier residents. A particular
program, for instance, may lobby to get a partner an interview. Lets say that Internal Medicine wants to
interview Partner A, but A is Couples Matching with Partner B who is applying in Orthopaedics. The
Internal Medicine program may then contact the Orthopaedics program to get person B an interview.
Another scenario is if two applicants are applying in the same specialty, lets say Pediatrics, at the same
institution. The Pediatrics program may treat the couple as individual applicants throughout the process,
until the program draws up their own rank list after the interviews. If Partner A is ranked 25 on their list
and Partner B is ranked 60, they will either move Partner B up, Partner A down, or put them both
somewhere in between.
A program may communicate with another department after it has made its rank list. If a program really
likes an applicant (Partner A) and the program knows s/he is Couples Matching, the program may call the
other department and find out where the other applicant (Partner B) sits on the rank list. This might help to
improve Partner Bs rank on his/her programs rank list. If the program breaks up its list in quartiles, for
example, a call from another department may not move Partner B from the second quartile to the first
quartile, but it may bump them up a few numbers within their established quartile. Some students have
been told that usually the stronger applicant carries the weaker one; so it is unlikely that an applicant will be
bumped down on the rank list because of a weaker applicant. Remember, the movement happen only if the
programs communicate with each other (some do and some dont) and they know to communicate only if
you have told them that you are Couples matching and with whom.

Is there any harm in informing programs that we are Couples matching?

Not likely. We can think of a couple of scenarios. One is if a program is small and would prefer not to take
more than one student from a particular school. If both applicants are strong, this might not be an issue, but
it is a consideration. We have also heard of a real life scenario where a same gender couple was concerned
about discrimination if they mentioned they were Couples Matching. In the end, the couple decided to tell
the programs, because they realized if they felt discriminated against at a certain program, they probably

-4would not be happy at that program. Overall, we think there is more benefit than harm that comes from
informing programs that you are Couples Matching.

When can we inform programs that we are Couples Matching?

1.

2.

3.

4.

Personal statement
We have heard some advisors recommend writing that you are Couples Matching, with the
name and specialty of your partner, in your personal statement. We do not know of anyone
who has done this, because it seems hard to fit it in, but its an option.
When scheduling interview
When you call to schedule your interview, it may help to mention you are couples matching if
you are trying to coordinate interview dates. Also, the Residency Coordinators often
appreciate knowing the information. See Interviews section below for more information on
coordinating interviews.
At the interview
a. Tell the residency coordinator and the residency director give name and specialty of
partner. Coordinators often will ask the applicant group if anyone is Couples Matching.
We found that there was often at least one other person Couples Matching in the applicant
group at each program we visited.
b. Consider asking the residency director if departments/institutions contact each other. Its
okay if you dont ask this (sometimes you might not feel comfortable asking). Some
residency directors will explain how the Couples Match works at their
program/institution without your having to ask.
c. Ask the coordinator or residents if there are couples in the program and which specialty
the partner is in. Think about getting in touch with those residents.
d. Ask residents about the possibility of coordinating vacations and call schedules. The chief
resident is usually responsible for coordinating vacation schedules, so you can ask him/her
if you dont get in contact with a resident who has Couples Matched.
In thank you/follow-up notes
a. Consider mentioning your partner in your thank you note. At the end of the note, after
you have written why you liked the program, write something like: My
(partner/husband/fianc/whomever) John Doe who is applying in (whatever specialty),
also enjoyed his interview day at the University of SuchandSuch.
b. When you finish up your interviews and have made a rank list, you might decide to write a
second note to the programs you have decided to rank in your top three or so. In this type
of note, you could write a bit about why you have chosen to rank the program highly. For
example, after completing our interview trips, my (partner) Janet Doe, who is applying in
(whatever specialty) and I have had a chance to discuss the programs and we have found
that your program fits our needs, both academically and personally.

Interviews
When should we interview?
Most programs seem to offer interviews in November through mid-late January, depending on the specialty.
You will have applied to around 25-30 programs, maybe more depending on your specialty. Try to aim to
go to at least 15 interviews, if you have been offered that many. If you are applying to particularly
competitive specialties, i.e. Dermatology or Orthopaedics, you might not have that many offers (which is
why you might want to start off by applying to more than 30 programs).

-5Some couples matchers recommend that couples plan on taking all of December and all of January off to
interview. Otherwise, you might not have enough time and it may get really hectic and stressful. One
approach is to plan to do all the programs in driving distance in December, and then do one big trip to the
Midwest and/or west coast in January, or vice versa. If you are planning to interview only in one
geographic area, you might not need quite as much time. We recommend interviewing at 2-3 programs per
week. If you need to fly or drive a long distance from one city to another, try to give yourself a day in
between interviews. It will be winter, in most of the US, so consider the hassles of winter travel when you
plan. Also, think about staying in a place for a couple days so you can get to know the city and enjoy the
activities it has to offer.

Should we try to coordinate our interviews?

It makes sense to try to schedule your interviews so you can travel together. This will save you money on
hotels and car rentals. Its also more fun and gives you a chance to see if the location offers what you want as
a couple. Its good to have someone to bounce ideas off of as you go. Often we found that our partner
could get a sense of how we felt about a program from our excitement or lack there of at the end of an
interview day.

How do we coordinate our interviews?

As soon as you receive an interview invitation, go ahead and schedule your interview. If one partner gets an
interview and other has not heard for a week or so, call to check on status of application. Tell them you are
Couples Matching and wanted to try to coordinate your interview dates.
If one partner is offered an interview at a program and the other is not, you can call your respective program
and request an interview. There is nothing wrong with being assertive as long as you are polite and friendly.
Explain the situation and, most likely, theyll be happy to accommodate you. If you are applying in the same
specialty and a program wants to interview Partner A but not Partner B, then the program knows it will
likely lose person A to another program that has chosen to interview person B also; or if the program
ultimately matches person A and but not person B, then person A may not be as happy because s/he's not
with person B. Basically, programs want you to be happy and, if being together means being happy, they do
what they can to help that happen.
One challenging situation we have seen is when one specialty starts offering interviews later than another.
This has happened with Orthopaedics, for example, in which many programs wait to see the Deans Letter
before offering interviews. This means that if the other person (Partner B) is applying in Pediatrics, for
example, s/he might already have 20 interview offers and will likely need to start going to the interviews
before Partner A has even heard from programs. This can lead to a lot of wasted time and cost, if Partner A
does not end up getting offers at certain programs where Partner B has already interviewed. If you find
yourself in this situation, try calling the programs of Partner A to see if s/he can find out early and call
Partner As programs to see if they can talk to Partner Bs programs and get them to offer an interview. In
the end, this might not help, but it could be worth a try.

Making the Rank List

How do we begin to make our Rank Order List (ROL)?

During your interview trip, write notes to remember what you liked and disliked about programs (see
Residency Program Evaluation Form attached at the end). One idea is to keep a running ROL, fitting
programs in as you visit them.

-6After you have finished interviewing, it might be helpful for each partner to make a list by ranking programs
individually, without considering the other person's favorite programs. This way you figure out where you
want to go, for you. After you have a rough list down, you'll need make a combined list, which requires
communication and compromise.

Suggestions for making the list

1. Fold paper in half lengthwise. One partner writes list on left. Other partner writes list on right.
Open paper and compare. Write combined list in the middle.
2. Put all of your combinations on index cards (with Partner A's programs in red and Partner B's in
blue). Group the cards by geographical areas, and then rearrange the order of the cards to end up
with a final ROL.

Determine your priorities

1. Living together
If you want to live together, each partner will need to correspond your program with one within
commuting distance.
2. Going for certain programs that are not near each other
If you are willing to live apart, that is your prerogative. You can also rank top choice programs that
are not close together first, and then rank the programs that are close together. This way, if you are not
accepted at your first choice program, then you would want to be together.
3. One partner is set on a particular program
If Partner A has his/her heart set one a particular program, you can organize your list to maximize
the chance of him/her matching at that program. An example is if Partner A wants to go to Baylor
more than anything, s/he can write Baylor for numbers 1-30. Partner B can then write Baylor for
number 1 (so they can be in the same city) and UCLA for number 2 (because that is his/her favorite
program) and then other 28 programs to which s/he applied to increase the possibility that Partner A
will get his/her first choice. If Baylor does not "accept" Partner A, then the computer will
automatically skip down to Partner A's number 31 (which is actually program choice 2), which let's say
is UCLA. UCLA "accepts" both of them and that's where they match. This case might happen if
Partner B does not want to be responsible for Partner A not getting his/her first choice. The couple is
willing to live apart so that Partner A has the best shot at going to Baylor.

What happens if we are applying for preliminary/transitional years and advanced

residencies?

This is complicated and may require guidance from administrators who have handled this before. The rules
are very similar to making a normal ROL, but there are just many more combinations for every
preliminary/transitional year. The couple can chose to link only the preliminary/transitional year, only the
advanced programs, or both. Once again, as a couple you must decide what your priorities are and whether
the location or the program is more important as discussed in the previous sections.
What program you go to for your preliminary/transitional year may not be as important as the advanced
program, so it may not be a dramatic compromise to link just the preliminary years, even though linking
advanced programs may be out of the question. In a particular specialty, there may be a few advanced
programs that are much stronger and may require the couple to be apart.

Sample ROL from the NRMP website (http://nrmp.aamc.org/nrmp/senior/couples.htm)

Special procedures are necessary to match couples to positions. The Match allows couples to form pairs of
choices that are then considered in rank order in the Match. Each partner's side of the list must have an equal
number of ranks. Both members of the couple must be active applicants in the Match.

-7Step 1
Each partner should first arrange an individual preference list on separate sheets of paper. In the following
example, the letters refer to a specific program in a particular hospital in that city.
Partner I
Partner II
1) New York City-A

1) Chicago-X

2) Chicago-A

2) Chicago-Y

3) Evanston-B

3) Boston-X

4) Los Angeles-A

4) Chicago-Z

5) New York City-B

5) New York City-X

6) New York City-Y

Step 2
Next, both partners must decide together how to prepare their lists as pairs of programs. For example, they
could consider all the possible pairings where the hospital programs are in the same general location, as
indicated in the list below. In some cases one rank in the pair may be designated "No Match" to indicate that
one partner is willing to go unmatched if the other can get a position. Note that the list below is not
necessarily in the order that will eventually be submitted.
Partner I
Partner II
New York City-A

New York City-X

New York City-A

New York City-Y

Chicago-A

Chicago-X

Chicago-A

Chicago-Y

Chicago-A

Chicago-Z

Evanston-B

Chicago-X

Evanston-B

Chicago-Y

Evanston-B

Chicago-Z

New York City-B

New York City-X

New York City-B

New York City-Y

New York City-A

No Match

-8Chicago-A

No Match

Evanston-B

No Match

Los Angeles-A

No Match

New York City-B

No Match

No Match

Chicago-X

No Match

Chicago-Y

No Match

Boston-X

No Match

Chicago-Z

No Match

New York City-X

Step 3
Now both partners decide the order in which these pairs are preferred. They might have a final Couples Rank
Order List of Paired Programs that looks like this:
Partner I
Partner II
1) Chicago-A*

Chicago-X

2) Chicago-A*

Chicago-Y* Match

3) Chicago-A*

Chicago-Z

4) Evanston-B

Chicago-X

5) Evanston-B

Chicago-Y*

6) Evanston-B

Chicago-Z

7) New York City-A*

New York City-X*

8) New York City-A*

New York City-Y

9) New York City-B*

New York City-X*

10) New York City-B*

New York City-Y

11) New York City-A*

No Match

12) No Match

Chicago-X

13) No Match

Chicago-Y*

-914) Chicago-A

No Match

15) No Match

Boston-X

16) Evanston-B

No Match

17) No Match

Chicago-Z

18) Los Angeles-A

No Match

19) No Match

New York City-X*

20)New York City-B*

No Match

The couple will match to the most preferred pair on their list where each partner has been offered a position
(the highest common denominator) [Note: choices 11 through 20 indicate that one partner is willing to go
unmatched if the other can get a position. Enter 999999 for the program code in these cases.]
If Partner I has offers from Chicago-A, New York City-A, and New York City-B, and Partner II has offers
from Chicago-Y and New York City-X, then this couple will match to the pair of programs that were ranked
second. If the Chicago programs had not accepted both partners, their match would have been their seventh
pair in New York City.

A Summary of Guidelines for the Preparation of Applicant Rank Order Lists from the
NRMP website

Applicants are advised to include on their Rank Order List only those programs that represent their
true preferences.

Programs should be ranked in sequence, according to the applicants true preferences.

Factors to consider in determining the number of programs to rank include the competitiveness of
the specialty, the competition for the specific programs being ranked, and the applicants
qualifications. In most instances, the issue is not the actual number of programs being ranked on the
Rank Order List, but the dilemma of whether to add one or more additional programs to the list in
order to reduce the likelihood of being unmatched.

Applicants are advised to rank all of the programs deemed acceptable to the applicant, i.e., a
program where they would be happy to undertake residency training. Conversely, if an applicant
finds certain programs unacceptable and is not interested in accepting offers from these programs,
said program(s) should not be included on the applicants Rank Order List.

It is highly unlikely that either applicants or programs will be able to influence the outcome of the
match in their favor submitting a list that differs from their true preferences.

- 10 Addendum I
Length of Residency Programs
The length of each bar represents the years of training required for certification. These are unofficial assignments and are offered for
informational purposes only. Consult the most recent Graduate Medical Education Directory for current official requirements. Many
specialties indicated as starting at the PGY-2 level now offer categorical tracks that include the first year.
Chart found at http://nrmp.aamc.org/nrmp/aboutres/index.htm
1
2
3
4
5
6-7
FAMILY PRACTICE
EMERGENCY MEDICINE
PEDIATRICS
SUBSPECIALTIES
INTERNAL MEDICINE
SUBSPECIALTIES
OBSTETRICS/GYNECOLOGY
PATHOLOGY
GENERAL
SUBSPECIALTIES
SURGERY
NEUROLOGICAL SURGERY
ORTHOPAEDIC SURGERY
OTOLARYNGOLOGY
UROLOGY
ANESTHESIOLOGY
TRANSITIONAL
DERMATOLOGY
or
NEUROLOGY
PRELIM
NUCLEAR MEDICINE
MEDICINE
OPHTHALMOLOGY
or
PRELIM
PHYSICAL MEDICINE
SURGERY
PSYCHIATRY
RADIOLOGY - DIAGNOSTIC
RADIATION ONCOLOGY